Medical
Supplies, Equipment, and Appliances (MSEA) is recognized in Kentucky Medicaid
as Provider Type 90. In order to enroll as a MSEA Provider with Kentucky Medicaid, see the Kentucky Medicaid Provider Enrollment website.
Covered Services
MSEA is equipment that withstands repeated use and primarily is used to serve a definite medical purpose. It is generally not useful to a person in the absence of an illness or injury. Medicaid covers MSEA such as wheelchairs, hospital beds, orthotic appliances (foot/leg braces) and prosthetic devices (artificial limbs), etc. and disposable medical equipment ordered by an accepted prescriber that is medically necessary and suitable for use in the home.
MSEA must meet the coverage provisions and requirements of 907 KAR 1:479 to provide covered services. Any services performed must fall within the scope of practice for the provider. Listing of a service in an administrative regulation is not a guarantee of payment. Providers must follow Kentucky Medicaid regulations. All services must be medically necessary.
Non-Covered Services
An item covered for Medicaid payment through another Medicaid program; Equipment that is not primarily and customarily used for a medical purpose.
- Physical fitness equipment;
- Equipment used primarily for the convenience of the recipient or caregiver; A home modification;
- Routine maintenance which includes testing, cleaning, regulating, and assessing the recipient's equipment;
- Back up equipment;
- An item determined not medically necessary, clinically appropriate, or reasonable by the department.
An estimated repair shall not be covered if the repair cost equals or exceeds: The purchase price of a replacement item; or the total reimbursement amount for renting a replacement item of equipment for the estimated remaining period of medical need.
MSEA shall not be included in the facility reimbursement for a recipient residing in a hospital, nursing facility, or intermediate care facility or institution for individuals with an intellectual or developmental disability.
Verify eligibility
Verify eligibility by calling the automated voice response system at (800) 807-1301 or visit the web-based KYHealth-Net.
Reimbursement
Reimbursement for Medical Supplies, Equipment, and Appliances are listed on the Kentucky Medicaid MSEA fee schedule which can be found on the Fee and Rate Schedule Home Page.
Reimbursement for Medical Supplies, Equipment, and Appliances is defined in regulation 907 KAR 1:479.
A provider may request coverage for a CPT or HCPCS procedure code by submitting a request in writing to the department which includes necessity, CPT or HCPCS code, and expected reimbursement. Any codes considered experimental are not covered by Kentucky Medicaid.
Duplication of Service
Kentucky Medicaid will not reimburse for a service provided to a beneficiary by more than one provider of any program in which the same service is covered, during the same time.
Prior Authorizations
Each MCO provides prior authorization for its beneficiaries.
Gainwell Technologies provides prior authorizations for fee-for-service (FFS) beneficiaries. For more information, visit
Prior Authorizations.
MAP-1001 advance member notice must be completed and signed by the member if an item or service was denied for failing to meet medical necessity or the supplier failed to obtain a prior authorization in a timely manner and the item and/or service already were provided to the member. This form allows the member to opt out of receiving the item with no financial responsibility or receiving the item and be responsible for paying for the item or service.
Claims Submission
Each MCO processes its own claims.
Kentucky Medicaid contracts with Gainwell Technologies to process the Kentucky Medicaid FFS claims. For more information, visit KYHealth-Net.
Coding
Kentucky Medicaid requires MSEA providers to bill on a CMS-1500 claim form utilizing the following code types where applicable:
- Current Procedure Terminology (CPT) codes, regulated by the American Medical Association (AMA).
- Healthcare Common Procedure Coding System (HCPCS) codes, regulated by the Centers for Medicare and Medicaid Services (CMS).
- Current Dental Terminology (CDT) codes, regulated by the American Dental Association (ADA).
- International Classification of Disease, Tenth Revision, Clinical Modification (ICD-10-CM) codes, maintained by the Centers for Disease Control & Prevention (CDC) and the National Center for Health Statistics (NCHS).
Kentucky Medicaid uses the Medicare National Correct Coding Initiative (NCCI) Procedure to Procedure (PTP) edits, the Medicaid Medically Unlikely Edits (MUEs), and the McKesson Claim Check System to verify codes mutually exclusive or incidental.
Claim Appeals
Appeal requests for denied FFS claims must be submitted to Gainwell Technologies. The request must include the
Provider Inquiry Form, reason for the appeal, and a hard copy claim.
Please refer to the member's MCO if appealing an MCO claim.
Timely Filing
Claims must be received within twelve (12) months from the date the service was provided, twelve (12) months from the date retroactive eligibility was established, or six (6) months of the Medicare adjudication date if the service was billed to Medicare.
Provider Inquiry Resources
If you cannot find the information you need or have additional questions, please direct your inquiries to:
- Billing Questions- Gainwell Technologies, (800) 807-1232, ky_provider_inquiry@gainwelltechnologies.com
- Provider Questions- (855) 824-5615
- Prior Authorization- Gainwell Technologies, (800) 292-2392, (800) 644-5725, (800) 807-8842
- Provider Enrollment, Maintenance, and Revalidation- (877) 838-5085
- KYHealth.net assistance- Gainwell Technologies, (800) 205-4696, ky_edi_helpdesk@gainwelltechnolgies.com
- Pharmacy Questions- (502) 564-6890, dmsweb@ky.gov
- Pharmacy Clinical Support Questions- (800) 477-3071
- Pharmacy Prior Authorization- (844) 336-2676
- Physician Administered Drug (PAD) list- (502) 564-6890
Managed Care Organizations
*Effective Jan. 1, 2025, Anthem is no longer an active Medicaid Managed Care Organization, or MCO, in Kentucky. However, they are responsible for the payment of claims, appeals, or disputes for dates of service up to and including Dec. 31, 2024.